Employment Interest
Last Accident:
Traffic Convictions and forfeitures for the past 5 years (Other than parking)
Last Traffic Convictions
Education
Last School Attended:
Special Qualifications or Skills
Previous Addresses
ACKNOWLEDGEMENT
TO BE READ AND SIGNED BY ALL APPLICANTS
I UNDERSTAND THAT IF I AM EMPLOYED BY FCI, EMPLOYMENT WILL BE "AT-WILL". THIS MEANS THAT IF EMPLOYED, I MAY RESIGN FROM MY EMPLOYMENT AT ANY TIME FOR ANY REASON WITH OR WITHOUT PRIOR NOTICE AND FCI MAY TERMINATE MY EMPLOYMENT AT ANY TIME FOR ANY REASON, WITH OR WITHOUT CAUSE, AND WITH OR WITHOUT PRIOR NOTICE. I UNDERSTAND THAT THIS APPLICATION DOES NOT CONSTITUTE AN EMPLOYMENT CONTRACT OF ANY KIND, EITHER EXPRESS OR IMPLIED.
EQUAL EMPLOYMENT OPPORTUNITY STATEMENT
Freehold Cartage, Inc., is an equal opportunity employer and does not discriminate against applicants or employees on the basis of race, color, creed, sex, national origin, age, religion, disability, marital status, veteran status, or any other characteristic protected by federal, state and/or local law. Women and minorities are encouraged to apply for open positions throughout the company. Applicants requiring a reasonable accommodation to complete and application and/or interview process should notify the Human Resources office.
I give FCI the right to contact and obtain information from all references, employers, educational institutions and to otherwise verify the accuracy of the information contained in this application. I hereby release from liability the employer and its representatives from seeking, gathering and using such information and any other persons, corporations or organizations from furnishing such information.
I certify this application was completed by me, and that all entries and information are true and complete to the best of my knowledge. Misrepresentation or material omission made by me on this application will result in either the denial of employment, or, if employed, the termination of my employment.
MOTOR VEHICLE DRIVERS
Your previous employer(s) will be contacted for the purpose of investigating your Safety Performance History as required by law 49 CFR 391.23 (d) and (e). If you were employed with Department of Transportation regulated employers during the preceding 3 years you have rights to due process regarding the investigative information provided by your previous employer(s):
- The right to review the information provided by previous employers.
- The right to have errors in the information corrected by the previous employer and for the previous employer to re-send the corrected information.
- The right to have a rebuttal statement attached to the alleged erroneous information if you and the previous employer cannot agree on the accuracy of the information.
If you wish to exercise your right to due process as outlined above, you must submit a written request to the Freehold Cartage Safety Director at any time, but not later than 30 days after beginning employment, or being notified of denial of employment.
IMPORTANT DISCLOSURE
THE BELOW DISCLOSURE AND AUTHORIZATION LANGUAGE IS FOR MANDATORY USE BY ALL ACCOUNT HOLDERS
REGARDING BACKGROUND REPORTS FROM THE PSP ONLINE SERVICE
In connection with your application for employment Freehold Cartage, Inc. (“Prospective Employer"), Prospective Employer, its employees, agents or contractors may obtain one or more reports regarding your driving, and safety inspection history from the Federal Motor Carrier Safety Administration (FMCSA).
When the application for employment is submitted in person, if the Prospective Employer uses any information it obtains from FMCSA in a decision to not hire you or to make any other adverse employment decision regarding you, the Prospective Employer will provide you with a copy of the report upon which its decision was based and a written summary of your rights under the Fair Credit Reporting Act before taking any final adverse action. If any final adverse action is taken against you based upon your driving history or safety report, the Prospective Employer will notify you that the action has been taken and that the action was based in part or in whole on this report.
When the application for employment is submitted by mail, telephone, computer, or other similar means, if the Prospective Employer uses any information it obtains from FMCSA in a decision to not hire you or to make any other adverse employment decision regarding you, the Prospective Employer must provide you within three business days of taking adverse action oral, written or electronic notification: that adverse action has been taken based in whole or in part on information obtained from FMCSA; the name, address, and the toll free telephone number of FMCSA; that the FMCSA did not make the decision to take the adverse action and is unable to provide you the specific reasons why the adverse action was taken; and that you may, upon providing proper identification, request a free copy of the report and may dispute with the FMCSA the accuracy or completeness of any information or report. I!f you request a copy of a driver record from the Prospective Employer who procured the report, then, within 3 business days of receiving your request, together with proper identification, the Prospective Employer must send or provide to you a copy of your report and a summary of your rights under the Fair Credit Reporting Act.
Neither the Prospective Employer nor the FMCSA contractor supplying the crash and safety information has the capability to correct any safety data that appears to be incorrect. You may challenge the accuracy of the data by submitting a request to https://dataqs.fmcsa.dot.gov. If you challenge crash or inspection information reported by a State, FMCSA cannot change or correct this data. Your request will be forwarded by the DataQs system to the appropriate State for adjudication.
Any crash or inspection in which you were involved will display on your PSP report. Since the PSP report does not report, or assign, or imply fault, it will include all Commercial Motor Vehicle (CMV) crashes where you were a driver or co-driver and where those crashes were reported to FMCSA, regardless of fault. Similarly, all inspections, with or without violations, appear on the PSP report. State citations associated with Federal Motor Carrier Safety Regulations (FMCSR) violations that have been adjudicated by a court of law will also appear, and remain, on a PSP report.
The Prospective Employer cannot obtain background reports from FMCSA without your authorization.
Authorization
If you agree that the Prospective Employer may obtain such background reports, please read the following and sign below:
I authorize Freehold Cartage, Inc. ("Prospective Employer") to access the FMCSA Pre-Employment Screening Program (PSP) system to seek information regarding my commercial driving safety record and information regarding my safety inspection history. I understand that I am authorizing the release of safety performance information including crash data from the previous five (5) years and inspection history from the previous three (3) years. l understand and acknowledge that this release of information may assist the Prospective Employer to make a determination regarding my suitability as an employee.
I further understand that neither the Prospective Employer nor the FMCSA contractor supplying the crash and safety information has the capability to correct any safety data that appears to be incorrect. I understand I may challenge the accuracy of the data by submitting a request to https://dataqs.fmcsa.dot.gov. If I challenge crash or inspection information reported by a State, FMCSA cannot change or correct this data. I understand my request will be forwarded by the DataQs system to the appropriate State for adjudication.
I understand that any crash or inspection in which I was involved will display on my PSP report. Since the PSP report does not report, or assign, or imply fault, I acknowledge it will include all CMV crashes where I was a driver or co-driver and where those crashes were reported to FMCSA, regardless of fault. Similarly, I understand all inspections, with or without violations, will appear on my PSP report, and State citations associated with FMCSR violations that have been adjudicated by a court of law will also appear, and remain, on my PSP report.
I have read the above Disclosure Regarding Background Reports provided to me by Prospective Employer and I understand that if I sign this Disclosure and Authorization, Prospective Employer may obtain a report of my crash and inspection history. I hereby authorize Prospective Employer and its employees, authorized agents, and/or affiliates to obtain the information authorized above.
DISCLOSURE AND AUTHORIZATION UNDER 49 C.F.R. PART 391.23
For purposes of an investigation in accordance with 49 C.F.R. Part 391.23, I authorize my previous employer(s), contractor (if owner operator), and trucking school(s), as applicable, to release and forward to Freehold Cartage, Inc. the following information for the past three (3) years.
Safety performance history information in accordance with 49 C.F.R. Part 391.23, which includes; employment dates, work history (which may include position held, reason for leaving, termination information, whether subject to the Federal Motor Carrier Safety Administration regulations, equipment experience, area driven, and other information as applicable) and accident information (including accident date, nature of accident, whether it was preventable, whether there were injuries, fatalities, or hazardous materials involved, and copies of any accident report).
Pursuant to Section 391.23(i) of the Federal Motor Carrier Safety Regulations, you have the following rights about the information released:
You have the right to make a written request at any time to review the information provided by previous employers, contractors (if owner operator), or trucking school, as applicable.
You have the right to have error in the information corrected by the previous employer, contractor(s) (if owner operator), or trucking school, as applicable and for that employer, contractor(s) (if owner operator), or trucking school to re-send the corrected information.
You have the right to have a rebuttal statement attached to the alleged erroneous information if the previous employer, contactor (if owner operator), or trucking school and you cannot agree on the accuracy of the information.
NOTICE: This form is made available to monthly account holders by NJC on behalf of the U.S. Department of Transportation, Federal Motor Carrier Safety Administration (FMCSA). Account holders are required by federal law to obtain an Applicant's written or electronic consent prior to accessing the Applicant's PSP report. Further, account holders are required by FMCSA to use the language contained in this Disclosure and Authorization form to obtain an Applicant's consent. The language must be used in whole, exactly as provided. Further, the language on this form must exist as one stand-alone document. The language may NOT be included with other consent forms or any other language.
